scholarly journals Surgical treatment of intravenous leiomyomatosis involving the right heart: a case series

2019 ◽  
Vol 47 (7) ◽  
pp. 3465-3474
Author(s):  
Guangze Luo ◽  
Hongrui Pan ◽  
Jiaxue Bi ◽  
Yudong Luo ◽  
Jiechang Zhu ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Case Series ◽  
Iliac Vein ◽  
Right Atrial ◽  
Intravenous Leiomyomatosis ◽  
Right Heart ◽  
The Right

Objective This study was performed to investigate the surgical treatment of intravenous leiomyomatosis involving the right heart. Methods The clinical data of five patients with intracardiac leiomyomatosis treated from April 2002 to October 2017 at a single center were retrospectively analyzed. Results All five patients underwent successful intravenous and right atrial tumor removal via abdominal and inferior vena cava incisions. In three patients, these incisions were combined with thoracotomy and a right atrial incision, and in two patients, they were combined with uterine and bilateral fallopian tube and ovarian resection. One patient with advanced disease underwent a one-stage procedure and died thereafter. Of the remaining four patients who underwent follow-up for 1.5 to 12.0 years, one developed recurrence at 1 year postoperatively. The recurrent tumor, which was pathologically confirmed to be an intravenous leiomyoma, was removed via inferior vena cava and internal iliac vein incisions without subsequent recurrence. Conclusions The main treatment goal for inferior vena cava leiomyomas involving the right heart is to first address the severe obstruction of cardiac blood flow and then pursue second-stage surgery. Concurrent thoracotomy appears unnecessary because moderately sized right heart tumors can be gently removed via the inferior vena cava.

scholarly journals A Case of Intravenous Leiomyomatosis Extending into the Right Ventricle through the Internal Iliac Vein and Inferior Vena Cava.

2001 ◽  
Vol 30 (1) ◽  
pp. 36-39
Author(s):  
Toshiaki Ohto ◽  
Masahisa Masuda ◽  
Naoki Hayashida ◽  
Yoko Pearce ◽  
Mitsuru Nakaya ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Right Ventricle ◽  
Inferior Vena ◽  
Vena Cava ◽  
Iliac Vein ◽  
Intravenous Leiomyomatosis ◽  
Internal Iliac Vein ◽  
Internal Iliac ◽  
The Right

scholarly journals P1704 An unusual mass in the right heart

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Wojtkowska ◽  
W Brzozowski ◽  
M Prasal ◽  
S Lukasik ◽  
E Czekajska-Chehab ◽  
...  
Keyword(s):  
Smooth Muscle ◽  
Inferior Vena ◽  
Histopathological Examination ◽  
Vena Cava ◽  
Premenopausal Women ◽  
Iliac Vein ◽  
Intravenous Leiomyomatosis ◽  
Right Heart ◽  
Benign Tumours ◽  
The Right

Abstract A 39 year old patient after removal of the uterus, the left oviduct and the right appendages due to Tu (massive fibroids). The histopathological examination revealed: leiomyomatosis intravascularis masiva (multifocal, intravenous smooth muscle cell hyperplasia without necrosis, cellular atypia and mitotic activity. Vascular invasion within the uterus, parametrium, mesovarium, perinodule tissues). The patient was admitted to the Gynaecology Clinic on the 9th postoperative day due to pain in the right lumbar region. The angio-CT of the thoracic, abdominal and pelvic cavities revealed a tumour/thrombus in the right internal iliac vein, common iliac vein and inferior vena cava (VCI). Then, the patient underwent transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) revealing an additional mass in the VCI entering the right atrium (RA), periodically passing through the tricuspid valve to the right ventricle (RV). The mass was of irregular shape, free-floating and did not obstruct the right ventricle inflow. Due to a suspicion of thrombus, an attempt at pharmacological treatment was initiated: initially LMWH at a therapeutic dose, followed by UFH iv. (controlled by APTT). Follow-up echocardiography: the image has not changed, the mass is still in the same location. The patient then underwent a surgical treatment: the pathological mass with a length of 35 cm was removed from VCI and RA with extracorporeal circulation. The histopathological examination confirmed: numerous foci of intravenous leiomyomatosis in the form of smooth muscle hyperplasia penetrating into the light of numerous vessels, mainly venous. Discussion Uterine fibroids are the most common benign tumours of the reproductive tract in premenopausal women, they are also the most common cause of hysterectomy. They are formed as a result of benign proliferation of myometrial smooth muscle cells. A special, though very rare, form is intravenous leiomyomatosis (IVL) - caused by abnormal growth of benign tumours, arising from smooth muscle, into venous vessels. Although histopathologically they are benign tumours, due to the possible invasion of large vessels they can be highly "aggressive" and extend into the heart chambers and pulmonary arteries (intracardiac leiomyomatosis - ICLM). Possible symptoms of ICLM: dyspnoea (30-37%), peripheral oedema (20-28%), chest pain (12-30%), palpitation (10-17%), fainting (11%). Approximately 13% of patients have no symptoms at all. In the differential diagnosis of masses in the right heart cavities, the following should be taken into account : thrombus, myxoma, metastases of malignant neoplasms, in particular renal cancer, as well as: liver cancer, adrenal cancer, lymphoma, leiomyosarcoma. Conclusion IVL should be taken into account as a differential diagnosis in case of a free-floating mass in the right heart chambers, originating from the inferior vena cava, among premenopausal women with a history of hysterectomy. Abstract P1704 Figure. mass in the right atrium

scholarly journals Obstruction of the inferior vena cava following bicaval orthotopic heart transplantation: a case series

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Anas Abudan ◽  
Brent Kidd ◽  
Peter Hild ◽  
Bhanu Gupta
Keyword(s):  
Inferior Vena Cava ◽  
Heart Transplantation ◽  
Inferior Vena ◽  
Rare Complication ◽  
Vena Cava ◽  
Case Series ◽  
Transoesophageal Echocardiography ◽  
Right Atrial ◽  
Orthotopic Heart Transplantation ◽  
Eustachian Valve

Abstract Background Inferior vena cava (IVC) obstruction is a rare complication of orthotopic heart transplantation (OHT) and is unique to bicaval surgical technique. The clinical significance, diagnosis, complications, and management of post-operative IVC anastomotic obstruction have not been adequately described. Case summary Two patients with end-stage heart failure presented for bicaval OHT. Post-operative course was complicated with shock refractory to fluid resuscitation and inotropic/vasopressor support. Obstruction at the IVC-right atrial (RA) anastomosis was diagnosed on transoesophageal echocardiography (TOE), prompting emergent reoperation. In both cases, a large donor Eustachian valve was found to be restricting flow across the IVC-RA anastomosis. Resection of the valve resulted in relief of obstruction across the anastomosis and subsequent improvement in haemodynamics and clinical outcome. Discussion Presumably rare, we present two cases of IVC obstruction post-bicaval OHT. Inferior vena cava obstruction is an under-recognized cause of refractory hypotension and shock in the post-operative setting. Prompt recognition using TOE is crucial for immediate surgical correction and prevention of multi-organ failure. Obstruction can be caused by a thickened Eustachian valve caught in the suture line at the IVC anastomosis, which would require surgical resection.

scholarly journals Isolated Marked Inferior Vena Cava Dilatation: Unusual Presentation or Underrecognized Common Phenomenon?

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Sneha R. Gadi ◽  
Benjamin K. Ruth ◽  
Alan Johnson ◽  
Sula Mazimba ◽  
Younghoon Kwon
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Unusual Presentation ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Common Phenomenon ◽  
Right Heart

Inferior vena cava (IVC) diameter and respirophasic variation are commonly used echocardiographic indices to estimate right atrial pressure. While dilatation of the IVC and reduced collapsibility have traditionally been associated with elevated right heart filling pressures, the significance of isolated IVC dilatation in the absence of raised filling pressures remains poorly understood. We present a case of an asymptomatic 28-year-old male incidentally found to have IVC dilatation, reduced inspiratory collapse, and normal right heart pressures.

scholarly journals Advanced Hepatocellular Carcinoma with Subtotal Occlusion of the Inferior Vena Cava and a Right Atrial Mass

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Christian Steinberg ◽  
Suzanne Boudreau ◽  
Felix Leveille ◽  
Marc Lamothe ◽  
Patrick Chagnon ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Inferior Vena Cava ◽  
Right Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Great Majority ◽  
Right Atrial ◽  
Advanced Hepatocellular Carcinoma ◽  
Regional Lymph Nodes ◽  
The Right

Hepatocellular carcinoma usually metastasizes to regional lymph nodes, lung, and bones but can rarely invade the inferior vena cava with intravascular extension to the right atrium. We present the case of a 75-year-old man who was admitted for generalized oedema and was found to have advanced HCC with invasion of the inferior vena cava and endovascular extension to the right atrium. In contrast to the great majority of hepatocellular carcinoma, which usually develops on the basis of liver cirrhosis due to identifiable risk factors, none of those factors were present in our patient.

Role of right heart receptors in the control of renin, vasopressin, and cortisol secretion in dogs

1992 ◽  
Vol 263 (5) ◽  
pp. R1071-R1077 ◽  
Author(s):  
D. H. Carr ◽  
D. B. Jennings ◽  
T. N. Thrasher ◽  
L. C. Keil ◽  
D. J. Ramsay
Keyword(s):  
Inferior Vena ◽  
Vena Cava ◽  
Plasma Renin ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Heart ◽  
Hormonal Responses ◽  
The Right ◽  
Maximal Reduction

We have reported that increased left heart pressure inhibits increases in plasma renin activity (PRA), arginine vasopressin (AVP), and cortisol during arterial hypotension. The goal of this study was to determine whether increases in right heart pressure also inhibited hormonal responses to hypotension. Seven dogs were chronically instrumented with inflatable cuffs around the ascending aorta (AA), the pulmonary artery (PA), and the thoracic inferior vena cava (IVC), as well as with catheters in both atria, the abdominal aorta, and vena cava. The IVC, the PA, and the AA cuffs were inflated on different days to cause step reductions in mean arterial pressure (MAP) of 5, 10, 20, and 30% below control MAP. Graded constriction of the AA caused large increases in left atrial pressure and plasma atrial natriuretic peptide (ANP), but had no effect on plasma AVP or cortisol and caused only a small increase in PRA at the maximal reduction of MAP. Constriction of the IVC reduced both atrial pressures and plasma ANP, but stimulated increases in PRA, AVP, and cortisol. Constriction of the PA increased right atrial pressure and plasma ANP and caused increases in plasma AVP and cortisol that were similar to responses during IVC constriction, but the PRA response was only half (P < 0.05). These results indicate that increasing pressure on the right side of the heart can attenuate the PRA response to hypotension, and suggest that the inhibition is mediated by the rise in plasma ANP.

Inferior Vena Caval Bullet Embolism

1996 ◽  
Vol 4 (3) ◽  
pp. 176-177
Author(s):  
Rajendar K Suri ◽  
Neerod K Jha ◽  
Virendar Sarwal ◽  
Arunanshu Behera ◽  
Ashok Attri ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Right Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Iliac Vein ◽  
Inferior Vena Caval ◽  
And Migration ◽  
The Right

We report a case of bullet penetration into the left iliac vein, with embolus into the inferior vena cava and migration up to the junction of the inferior vena cava and the right atrium. The bullet was subsequently extracted through laparotomy from the infrarenal segment of the inferior vena cava, just above its bifurcation.

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